Talk:Post-concussion syndrome

Should not this be mentioned? As a layperson I see no clear differences.

^[1]

~~ —Preceding unsigned comment added by Elemming (talk • contribs) 07:43, 26 October 2010 (UTC)

It should be mentioned if there is a link. However I did a google scholar search and only found 5 hits for 'post-traumatic headache syndrome' and none seemed to mention post-concussion syndrome. --sciencewatcher (talk) 13:34, 26 October 2010 (UTC)

This passage is either intentionally misleading, or not precise enough in what it entails. For instance, severity of symptoms and likelihood of litigation are profoundly confounded variables and this is not well documented in the section. It seems that the passage is trying to make the point that because the disorder is not well understood it is likely abused by attorneys and victims of trauma, but never makes this point explicit, and rather relies on "statistical trickery" (not necessarily on the part of the author) to make the claim that because litigation and severity of symptoms are positively correlated that it is likely that litigation increases the severity of these symptoms, which is undecidable. It should either be directly explained that the relationship is causal, or interpreted as an open question, for which the only evidence is speculation. I will only edit this section out once more, and after that I will leave it to the rest of the community.

108.67.152.150 (talk) 08:11, 17 November 2010 (UTC)

when this section was deleted, one reference to malingering remained in the article. i linked that instance to the wiki article and also put in a very short definition of it in the text.

additionally, although i haven't gone thru the article's history to read the section that was removed (more than once, apparently), i tend to agree that an entire section on it should not be in this article. for one thing, this article seems to have been primarily written/edited about 2008. there has been more study on this very question since then. (i'm going to add a new Talk section about this.) if there is no section on "malingering" on most of the wiki articles on diseases and disorders, then i don't see why there should be one for this particular disorder/syndrome. (as i noted, there has been further research.)Colbey84 (talk) 08:26, 27 November 2016 (UTC)

Does brain injury link NFL players, wounded warriors?, CNN, Stephanie Smith, May 16, 2012.

“ . . CTE derives some of its notoriety from cases like that of Dave Duerson, a former Chicago Bear who shot himself in the chest in 2011 and was found to have dense clusters of tau protein permeating his brain and spinal cord.

“Tau is released by neurons when the brain is rocked inside the skull and, when unleashed, tends to lodge in parts of the brain responsible for memory, judgment and mood.

“The same group of researchers at the Boston University School of Medicine who examined Duerson's brain excised thin slivers of brain tissue from four U.S. veterans who died suddenly. Those were compared to tissue taken from two other groups: three amateur football players and a professional wrestler with a history of concussion; and a control group of four young people who died suddenly with no history of concussion. . ”

" . . What the mouse study does is ask a very specific question lingering in the field, which is, can exposure to even a single blast result in brain damage that persists and possibly progresses?" Goldstein said.

“To answer that question, researchers exposed a group of mice to blast winds -- some up to 330 miles per hour -- that mimic what might occur in the wake of an IED blast and compared them to a group of mice the same age, living in the same conditions, that were not exposed to blasts.

“The effect of the blast is described by researchers as a "bobblehead effect," the brain rocking back and forth inside the skull, similar to what happens during a concussion, and in some people it leads to brain damage.

“Two weeks after exposure to the blast, brain tissue in mice showed evidence of tau protein. . ”

I don't think our article currently discusses tau protein at all, and we probably should. FriendlyRiverOtter (talk) 18:47, 23 May 2012 (UTC)

...but not from the CNN website. See WP:MEDRS. --sciencewatcher (talk) 22:39, 23 May 2012 (UTC)

It's a reputable news agency, right? And it's in terms the lay person can understand. I generally prefer a variety of sources. FriendlyRiverOtter (talk) 22:48, 23 May 2012 (UTC)

Yes, but it fails WP:MEDRS - we shouldn't be using it for medical statements. Instead we should be relying on reviews in peer-reviewed journals. I had a quick look on google scholar, and the reviews seem to say that tau protein is not useful for diagnosing PCS. --sciencewatcher (talk) 23:11, 23 May 2012 (UTC)

Tau has been found in the autopsies of a number of football players. So, if the doctor has to wait for the patient to die, no, it probably isn't useful as a diagnostic tool. But it may be part of the physiological explanation of how repeated (even minor) concussions can cause real damage.

And I guess this might be a good time to point out, no, I am not a doctor, nor am I a medical researcher. I'm just someone of average intelligence interested in the topic. FriendlyRiverOtter (talk) 23:25, 23 May 2012 (UTC)

from . .

Wikipedia:Identifying reliable sources (medicine)

“ . . biomedical information in articles be based on reliable, third-party, published sources and accurately reflect current medical knowledge.

“Ideal sources for such content includes general or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies. . ”

Notice the first part, "reliable, third-party," that would include medical journalists. And the second part, the "Ideal sources" which include "systematic reviews" in medical journals and professional books written "by experts," well, it all depends on how good the expert is at writing! He or she may not be intending the general, nonspecialist audience at all. Again, we might be better off with a good medical journalist who's not afraid to put it in English. And the last part, "recognised expert bodies," that may be medical orthodoxy. That may be the work of a committee, and it may show. FriendlyRiverOtter (talk) 23:44, 23 May 2012 (UTC)

TRAUMATIC BRAIN INJURY Chronic Traumatic Encephalopathy in Blast-Exposed Military Veterans and a Blast Neurotrauma Mouse Model, ABSTRACT, Science Translational Medicine, Goldstein, Fisher, Tagge, et al., Vol. 4, Issue 134, 16 May 2012.

“We examined a case series of postmortem brains from U.S. military veterans exposed to blast and/or concussive injury. We found evidence of chronic traumatic encephalopathy (CTE), a tau protein–linked neurodegenerative disease, that was similar to the CTE neuropathology observed in young amateur American football players . . ”

“ . . a blast neurotrauma mouse model . . ”

“ . . The contribution of blast wind to injurious head acceleration may be a primary injury mechanism . . ”

Agree with sciencewatcher. We need secondary reviews in the literature, especially in humans. Mouse studies do not count. Yobol (talk) 19:17, 25 May 2012 (UTC)

The mouse studies are one line of evidence. This same article also talks about autopsies on military veterans and football players. FriendlyRiverOtter (talk) 20:19, 25 May 2012 (UTC)

It's not just because it's on mice...it's also because it's a primary source. I'd urge you to read WP:MEDRS thoroughly. --sciencewatcher (talk) 21:59, 25 May 2012 (UTC)

So, we can't use good, straightforward, middle-of-the-road medical journalism, and we can't use primary sources either? It sure seems like we have put ourselves into an unnecessarily small box. FriendlyRiverOtter (talk) 17:56, 26 May 2012 (UTC)

And what about the Fifth Pillar: "Wikipedia does not have firm rules. Rules in Wikipedia are not carved in stone, . . . . and sometimes improving Wikipedia requires making an exception to a rule. . "

Certainly we can make exceptions, but this doesn't seem to be one of those cases. There are good reasons why we don't generally use primary sources in wikipedia, especially in medical articles. --sciencewatcher (talk) 18:35, 26 May 2012 (UTC)

What about the immediate below section that our first sentence just seems to be flat-out mistaken? FriendlyRiverOtter (talk) 18:40, 26 May 2012 (UTC)

And not just mouse study at all. "“We examined a case series of postmortem brains from U.S. military veterans . . " What I did, I took the CNN article and then I also included the professional publication CNN refers to. I think this is a pretty good way. It may not be "perfect" or "ideal." But this may be a case in which we are letting the perfect be the enemy of the good. FriendlyRiverOtter (talk) 19:45, 26 May 2012 (UTC)

It's still a primary source, single study so it fails WP:MEDRS. We can ignore MEDRS but only in exceptional circumstances. As stated above, there are very good reasons why we don't include studies like this - I think you should read WP:MEDRS to find out why... --sciencewatcher (talk) 20:36, 26 May 2012 (UTC)

CNN is not a primary source. CNN is a secondary source with a presumably seasoned medical reporter.

“ . . biomedical information in articles be based on reliable, third-party, published sources . . ” That includes mainstream journalism. FriendlyRiverOtter (talk) 20:59, 26 May 2012 (UTC)

CNN is a secondary source, but it fails WP:MEDRS badly. Again I'd suggest you read WP:MEDRS. --sciencewatcher (talk) 15:46, 27 May 2012 (UTC)

As I quoted from the first paragraph of WP:MEDRS above, on a straightforward reading it sure seems like this would include good, solid, mainstream medical journalism.

And please take a look at the below problems. This article needs a lot of help. If you have the time, I invite you to please help with some of the research. FriendlyRiverOtter (talk) 17:39, 29 May 2012 (UTC)

Yes, but read the second paragraph in WP:MEDRS. Also see the Popular press section: "The popular press is generally not a reliable source for scientific and medical information in articles". --sciencewatcher (talk) 18:01, 29 May 2012 (UTC)

Okay, continuing on with WP:MEDRS we have: "The popular press is generally not a reliable source for scientific and medical information in articles. Most medical news articles fail to discuss important issues such as evidence quality,[8] costs, and risks versus benefits,[9] and news articles too often convey wrong or misleading information about health care.[10] Articles in newspapers and popular magazines generally lack the context to judge experimental results. They tend to overemphasize the certainty of any result, for instance, presenting a new and experimental treatment as "the cure" for a disease . . . "

This is a caricature of the "popular press." If you look at CNN, or perhaps even more so ESPN which has done some excellent reporting on football and concussions, they have talked about evidence quality and how much weight to place on a particular study. I remember Dr. Sanjay Gupta being interviewed by a desk anchor on CNN about a concussion study. You're asking a doctor to put a study into lay language. And he wants to do a good job because he wants to maintain a good reputation with his professional colleagues. Perhaps it's not really peer review (which is not perfect either, for it has all the drawbacks of a committee), but it's a kind of peer review. Arguably, it's even a transparent kind of peer review. And ESPN has perhaps done even better reporting, because the journalists have examples of injuried athletes who they can ask doctors about, and thus get a healthy interchange going between theory and practice. And also shades of Dr. William Osler, one can learn a lot from the individual case study (yes, I am pretty well read, and when I was a younger person, I thought about medical school but it's not quite for me).

Perhaps the dialogue comes down to this: If we include CNN or ESPN, there is a theoretical risk that we might be wrong. But I think we're already wrong! Our very first sentence mis-emphasizes (let's put in that way) the time periods involved. (And after stating "weeks, months, or occasionally up to a year," the hedge phrase of "or more" is not near good enough. And other parts of this opening paragraph emphasize short-term. And that isn't always the case.)

The real downside of the purist, only-the-"best" sources seems to be that it's such a high threshold that the work hardly ever gets done. FriendlyRiverOtter (talk) 18:41, 29 May 2012 (UTC)

Agree with Yobol, user in question needs to provide recent secondary sources. Doc James (talk · contribs · email) 21:43, 29 May 2012 (UTC)

"Post-concussion syndrome, also known as postconcussive syndrome or PCS, and historically called shell shock,^[1] is a set of symptoms that a person may experience for weeks, months, or occasionally up to a year or more after a concussion – a mild form of traumatic brain injury (abbreviated TBI). . . "

" . . occasionally up to a year or more . . " No, incorrect, there are guys who are retired NFL players who have had serious symptoms for a lot longer than a year. Watch some ESPN in recent weeks and see this. And maybe this is a case in which just people telling their stories is running ahead of formalized research. Although I suspect this is the wiki disease of understating. When in doubt, when there's controversy, just understate, sand it down even more. Well, we end up doing our readers a disservice. If we have the sources to back it up (good not perfect sources) I don't think we need to excessively understate.

And the part about shell shock, I have most commonly heard that in reference to World War I and I've heard it described as serious depression. Well, maybe the concussive injuries were the cause of a lot of these cases of depression. "Shell shock" is how they best understood it at the time. I'm not sure we should lead with a historical term which is partially right, partially not. FriendlyRiverOtter (talk) 00:01, 24 May 2012 (UTC)

And look at the last sentence of the opening paragraph: " . . In late, persistent, or prolonged PCS (PPCS), symptoms last for over six months, or by other standards, three."

We are again emphasizing short-term. At the very least, we are taking a definite viewpoint when there is still considerable controversy and unknown. And actually, a lot of the news coverage is emphasizing a heck of a lot longer than six months. FriendlyRiverOtter (talk) 18:56, 26 May 2012 (UTC)

The lead is confusing in the proposed timing, wandering around between short term, long term and short term onset.

The shell shock part confusion is due to WWI misinterpretation of combat stress reaction, it was thought at the time, that the injury was due to explosives injuring the brain. Later study found that the issue was psychological, which is the current belief. There also seems to be some confusion in concepts. One can have traumatic brain injury that doesn't cause long term issues and one can have traumatic brain injury that causes damage that the brain cannot compensate for. The tau protein detection is an early finding in research that indicates damage has occurred in the past, with some being probable multiple injury induced changes. Even so, it's rather outside of the scope of the article, as it is ongoing research that is still poorly understood and utterly useless in diagnosing PCS. Head trauma is still not well understood. Relatively mild head injuries can result in significant emergent conditions, while more severe injuries can result in no significant medical issues, with little to lead researchers anything to ascertain why there is such a wide difference in spectrum with disparate mechanisms of injury. As an example, a man is hit with a back hoe and thrown two meters, his head being part of what was struck by the bucket. He got up and returned to work, only reporting bruising. Another man fell off the lowered back gate of a truck he was climbing into, landing on an unimproved dirt road. He was hospitalized for a subdural hematoma after complaining of vision changes several hours later. So, we have to consider when writing our rather poor level of understanding injuries of the head overall and the current extremely poor understanding of concussions in general.Wzrd1 (talk) 00:21, 15 August 2012 (UTC)

The Causes section is generally taking the either-or approach, whereas I think the newer understanding is that it's BOTH-AND. That both interact to cause a downward spiral.

In general, our article here needs a lot of work. And perhaps paradoxically, maybe we should seemingly lower our standards and go with a healthy number of good sources, rather than a scant number of 'perfect' or 'great' sources. FriendlyRiverOtter (talk) 00:15, 24 May 2012 (UTC)

i agree. 4 1/2 years later, the article still needs work. i found the article quite slanted when i read it. it's the little things--use of phrases like "most experts agree," "it has been argued," "it appears that," and "it has been argued," etc. then, the sources related to these phrases are quite out of date. especially for a medical article, and especially for a medical "issue" that has gotten a LOT of interest lately.Colbey84 (talk) 08:37, 27 November 2016 (UTC)

The whole news coverage on concussions and brain injury, that it’s typically not the first concussion. But rather that it’s the fourth, or the seventh, or the second, that it is highly variable depending on each individual. For example, let’s say a cyclist (not just to pick on football) has experienced a concussion and has largely recovered, and this cyclist asks his or her doctor: “Doctor, will I be okay even if I get a second concussion?”

As I understand it, with current knowledge and information, the doctor cannot say one way or another. (although with each concussion, the third, the fourth, the fifth, the risk increases that the next one will prove to be damaging).

This has been a central fact in the news coverage of concussions. And yes, I think someone who has maybe worked ten years or longer as a medical journalist, like a reporter for CNN, LA Times, etc, etc, etc, often are pretty good sources. They can act as ‘bridge’ persons between medical publications written for doctors and interested lay persons like ourselves. And we don’t need to dive into how much experience a particular medical journalist has or what his or her credentials are. Rather, this is where we trust the credibility of the source (with all kind of judgment calls on our part of course). And so, I come back to the not very dramatic conclusion that we want a variety of good sources.

And to be clear, I am not a medical journalist either. I am just someone who is interested in the topic.FriendlyRiverOtter (talk) 19:34, 26 May 2012 (UTC)

1) We don't mention tau protein.

2) We don't mention in the lead that it's primarily a danger of subsequent concussions.

3) The first sentence of our entire article estimates lower time periods, and this is simply not always the case.

4) We are taking an either-or approach to the question of physiological or psychological.

I ask people who can spare the time to please jump in and help out with both the writing and the research. FriendlyRiverOtter (talk) 21:01, 26 May 2012 (UTC)

Maybe it did at one time, and we didn't keep it. Or maybe it's been changed over time.

I have pretty much decided to request and recommend that this article be demoted from being classified as a Natural sciences good article. Now, in keeping with the spirit of openness, I invite people's comments. And I'm willing to wait a couple of days. In fact, I hope the discussion both informally and more formally about whether to demote this article will draw people in with the interest and, more importantly, the time to make our article better.

As it currently stands, if a young person is in the 10th grade and is thinking about medical school, or if he or she is a senior in college, I don't see how our article does that good a job in providing an overview of known information. Or, if our reader is a parent who has a 14-year-old son interested in playing football, I don't see how our article provides a very good overview of what is known regarding post-concussion syndrome. In fact, we might end up doing that parent a disservice. FriendlyRiverOtter (talk) 21:10, 26 May 2012 (UTC)

I think the main problem here is you are confusing this page with Chronic traumatic encephalopathy. It may be better for you to slow down, read this page and that page and understand the difference before posting further. Yobol (talk) 21:51, 26 May 2012 (UTC)

In the big swaths I have read, I have seen what sure appears to be substantial problems with our article as it's currently written. No, I don't think I am going to slow done, other than holidays and family activities of course.  :>)

Our article as it currently stands needs a fair amount of help. If you have the interest and can spare the time, please consider jumping in and helping with the research. FriendlyRiverOtter (talk) 17:50, 29 May 2012 (UTC)

ORIGINAL ARTICLE, “Permanent post-concussion symptoms after mild head injury,” Brain Injury, 25(5): 462–470, NIGEL S. KING & SIMON KIRWILLIAM, May 2011.

Introduction

“ . . ‘mild head injury’ (MHI) . . ”

“ . . ‘postconcussion symptoms’ (PCS) . . ”

“ . . Twenty-to-forty per cent may, however, continue to experience PCS at 6 months post-injury [5] and a small minority still have difficulties at 1 year and beyond [6]. . ”

“ . . Studies have also identified predisposing factors to experiencing more severe or longer lasting PCS. These include; (i) being over the age of 40 [11, 12]; (ii) being female [12, 13]; (iii) sustaining previous MHIs [12, 14]; (iv) having pre- or post-morbid psychopathology or substance misuse [15]; and (v) pursuing a compensation claim [16]. . ”

References

[5.] Englander J, Hall K, Simpson T, Chaffin S. Mild traumatic brain injury in an insured population; subjective complaints and return to employment. Brain Injury 1992;6:161–166.
[6.] Binder LM, Rohling ML, Larrabee GJ. A review of mild head trauma. Part 2: clinical implications. Journal of Clinical and Experimental Neuropsychology 1997;19:432–457.
.
.
[12.] Edna TH, Cappelen J. Late postconcussional symptoms in traumatic head injury. An analysis of frequency of risk factors. Acta Neurochirurgica 1987;86:1–12.
.
[14.] Gronwall D, Wrightson P. Cumulative effects of concussion. Lancet 1975;2:995–999.

My local library has databases which includes Brain Injury, including a PDF of the full article. I'm not sure whether it's available generally over the Internet.

Here's the abstract: http://informahealthcare.com/doi/abs/10.3109/02699052.2011.558042 But apparently one needs to log in to see the entire article. FriendlyRiverOtter (talk) 19:45, 29 May 2012 (UTC)

Introductions to primary sources do not act as reviews. Pubmed has a button on the left side that will limit your search to review articles. Please use reviews from the last 5 or 10 years at most. Cheers Doc James (talk · contribs · email) 21:30, 29 May 2012 (UTC)

I am concerned by the recent additions which seem to be adding material about concussions in general, rather than a discussion about post-concussion syndrome in particular. This does not seem appropriate here. Yobol (talk) 22:33, 14 June 2012 (UTC)

Yes agree completely. This content would belong on the page on concussion rather than here. Will I appreciate FriendlyRiverOtter efforts I have returned the page to how it was before. Before we said "Post-concussion syndrome is usually not treated" and this was changed to "The cornerstone of concussion management is physical and cognitive rest". While the latter is indeed true it applies to concussion.Doc James (talk · contribs · email) 03:48, 15 June 2012 (UTC)

Is that true, that post-concussion syndrome is usually not treated?

Because not according to the Merck source. FriendlyRiverOtter (talk) 20:01, 15 June 2012 (UTC)

You are indeed correct and I have corrected the text to match the source.Doc James (talk · contribs · email) 20:34, 15 June 2012 (UTC)

The Merck source discusses both concussions and PCS. It is important that we discuss the two separately and not conflate them. When the Merck source does not describe PCS specifically, we should assume it is discussing concussions in general. Yobol (talk) 20:02, 15 June 2012 (UTC)

There's going to be some overlap. I think we should accept that. From 2008 Consensus Statement:

McCrory, P (2009 Jul-Aug). "Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008". Journal of athletic training. 44 (4): 434–48. PMID 19593427. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

“ . . The panel, however, unanimously retained the concept that most (80–90%) concussions resolve in a short period (7–10 days), although the recovery time frame may be longer in children and adolescents. . ”

So, we can begin to ask, Does that mean symptoms and treatment past 7-10 days are talking about post-concussion?

Now, in the case of Merck, we get lucky. They directly use the phrase. But we're not always going to have that luxury. FriendlyRiverOtter (talk) 20:15, 15 June 2012 (UTC)

[24] The Merck Manual Home Health Handbook, Concussion, last full review/revision January 2008 by Kenneth Maiese, MD. The last paragraph reads:
"Treatment for postconcussion syndrome is based on the severity of the symptoms. Rest and close observation are important. People who experience emotional difficulties may need psychotherapy. Repeated concussions may increase a person's risk in later life for dementia, Parkinson's disease, and depression. People should not return to contact sports after a concussion until all ill effects have resolved and medical evaluation has been completed."

I will update our article to reflect this. And, I could use some help checking content against references. FriendlyRiverOtter (talk) 20:22, 15 June 2012 (UTC)

There should be minimal overlap. This is not the article on concussions. This is a different article, and we should not provide information on one when it is more appropriate in another article. From an article that focuses on concussions in general, and mentions PCS briefly, unless it specifically discusses mention PCS we should assume they are discussing concussions in general. There is no reason to use general "concussion" sources when we have multiple good sources which speak to PCS specifically. Yobol (talk) 20:25, 15 June 2012 (UTC)

And I have reverted the addition which discusses concussion in general to treatment section. As PCS can last for months, it makes no sense that "rest and close observation" be the treatment for this condition. Yobol (talk) 20:33, 15 June 2012 (UTC)

Changed it slightly. Do you think that is a fair balance? The ref does not say treatment is nothing but says it is rest and potentially psychotherapy. Close observation is not really a treatment.Doc James (talk · contribs · email) 20:37, 15 June 2012 (UTC)

I'm not sure why we're even using the Merck source; we have multiple review articles cited, which would probably be better sources. I'll go through some at some point, but "rest" as a treatment for a condition that can last for months makes little sense to me (but makes plenty of sense as a treatment for acute concussion). Yobol (talk) 20:39, 15 June 2012 (UTC)

Yobol, neither one of us are doctors (I don't think. I know I'm not a doctor, I guess the baseline is that approximately 1 out of 500 (?) persons is). I really don't want to question the references other than other areas we can research. Now, Doc James is a doctor. But if anything he faces a greater challenge. Doc James, I'm sure you know you can't just speak freely like you might on TV and educate the public, right? I mean, the talk page to a considerable extent, but the article itself, has to be right down the middle with references. My guess is, that it's probably harder for a doctor just like it would be harder for an expert on the Renaissance to update that page. FriendlyRiverOtter (talk)

I think the Merck source conflates concussions and PCS too much, (and think that the treatment discussion conflates them as well) and would prefer to use sources that speaks specifically to PCS, especially when we have multiple review articles available for that purpose (which are our preferred source per WP:MEDRS. I will eventually go through these review articles, but have my priorities elsewhere at the moment. Yobol (talk) 20:50, 15 June 2012 (UTC)

I am starting to ask myself, does the professional literature draw that big a distinction between concussion symptoms and post-concussion symptoms? FriendlyRiverOtter (talk) 21:37, 16 June 2012 (UTC)

Yobol, I think you bring up a very good point when you basically say, yes, I can see how rest makes plenty of sense as treatment in the immediate aftermath of a concussion, but for symptoms which have gone on for several months, how much good is additional rest really going to do? And this highlights the potential seriousness of post-concussion syndrome. Serious, potential lifetime injury, yes, sadly the case. All the stuff I've read and skimmed, the only treatment I can recall which might help is the example and analogy of antidepressants being given (still experimentally?) to stroke victims in an effort to grow additional nerve connections. (Standard advice for antidepressants is that the first one tried may not 'click' for a particular patient, but another one may. And also, often important to step down in phases.) I'd very much like to have the references for additional treatments.

From the 2008 Consensus Statement: " . . retained the concept that most (80–90%) concussions resolve in a short period (7–10 days) . . " So maybe the gray area is day 11, 12, 13, and running into several weeks. That's perhaps where additional rest, both cognitive and physical, might really make a difference. Plus, the whole concept of the stepwise return which the consensus statement talks about. FriendlyRiverOtter (talk) 17:42, 18 June 2012 (UTC)

Physicians must be brought up to speed on concussion risks, CMAJ News, Canadian Medical Association Journal (CMAJ), Jordan Fallis, Vol. 184 (2), February 7, 2012, (first published electronically December 19, 2011).

" . . . Revisions to international concussion guidelines are also needed, the panelists argued [special seminar on concussions in hockey held at Scotiabank Place in December 2011]. The current guidelines were developed in 2008, when the Third International Conference on Concussion in Sport developed the Consensus Statement on Concussion in Sport, which lays out evidence-based guidelines for physicians, trainers and other health care professionals on how to treat concussed patients (http://sportconcussions.com/html/Zurich%20Statement.pdf). An update is expected to be released after a conference to be held in Zurich, Switzerland in November 2012."

So, when this comes out, we can read it and possibly incorporate parts of it into our article. And at the same time, we can also look for other good sources. FriendlyRiverOtter (talk) 18:47, 25 June 2012 (UTC)

I was just reading the source for this claim, and it doesn't convincingly show that (depending on what exactly is meant by 'psychological'). The author may believe this is true, but that would only justify saying something like "Some researchers are convinced that it has been shown that psychological factors play an important role in the presence of post-concussion symptoms."

Given the difficulty of meaningfully diagnosing PCS and the potential for confounding factors, I think that this claim needs to be more cautiously phrased. Evidence that, post-concussion, those with on-going symptoms are also likely to develop emotional or cognitive cannot really be used to claim that they play an important role in the presence of post-concussion symptoms, particularly given how little we understand as to what causes people to suffer from mental health problems. — Preceding unsigned comment added by 87.115.186.110 (talk) 01:40, 9 November 2013 (UTC)

the DSM V is out and it doesn't have "postconcussional disorder" in it. so all references to that should either be removed, or adjusted to show that it is only in the DSM-IV (and maybe earlier). i'd think this is obvious/factual enough, but if a source is needed: http://www.acnr.co.uk/2015/04/postconcussion-syndromedisorder-or-mild-traumatic-brain-injury-diagnostic-issues-and-treatment/ or, to show that others were wondering about it: https://www.researchgate.net/post/Where_did_the_Post-Concussive_Disorder_of_DSM- Colbey84 (talk) 13:13, 27 November 2016 (UTC)

some of the sources are pretty old, especially for a medical article, and especially for a medical topic that has had a LOT of interest. combining these older sources with the use of phrases like "most experts agree," "it has been argued," "it appears that," "it has been argued" (and others) makes this article appear slanted. i mean, one of these sources is from 1995, and as was noted on this Talk page in another section, we should "use reviews from the last 5 or 10 years at most."

i don't have time to really dig into this (or into editing this page), but i note that others have shown quite an interest in this article, so maybe someone will find the time to work on this. i did find some possible sources. this one was mentioned before on this Talk page, but it was updated, so this is a link to the newer version: "Military blast exposure, ageing and white matter integrity" http://brain.oxfordjournals.org/content/138/8/2278

but the biggest issue with this article is now summed up by this: "A longstanding controversy surrounding PCS concerns the nature of its etiology..." and then the way the rest of the article is presented (as i noted, with the above phrases). i don't know for sure whether this is still a controversy, but my quick perusal of some of the following sources seems to indicate that it's not. or not as much of one.

• "Postconcussive Syndrome in the ED" – Sep. 2016

http://emedicine.medscape.com/article/828904-overview "While recent research has shown that psychological factors may be present early, other studies using imaging techniques such as magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and magnetoencephalography (MEG) have demonstrated the presence of organic brain injury in patients with persistent postconcussive syndrome at greater than 1 year after injury."

• "Classification and Complications of Traumatic Brain Injury" – June 2016:

http://emedicine.medscape.com/article/326643-overview

• "Role of Pre-Morbid Factors and Exposure to Blast Mild Traumatic Brain Injury on Post-Traumatic Stress in United States Military Personnel." – Mar. 2016:

https://www.ncbi.nlm.nih.gov/pubmed/27027526

• "Traumatic Brain Injury (TBI) - Definition and Pathophysiology" – 2015:

http://emedicine.medscape.com/article/326510-overview

• "Prevalence of mental health conditions after military blast exposure, their co-occurrence, and their relation to mild traumatic brain injury." – 2015:

https://www.ncbi.nlm.nih.gov/pubmed/26479126

• "Mild traumatic brain injury and postconcussive syndrome: a re-emergent questioning" – 2012:

https://www.ncbi.nlm.nih.gov/pubmed/22980474

• "CURRENT CONTROVERSIES IN TRAUMATIC BRAIN INJURY" – 2011:

http://www.aqua.ac.nz/upload/resource/Current%20controversies%20in%20traumatic%20brain%20injury.pdf

• "Mild traumatic brain injury (concussion) during combat: lack of association of blast mechanism with persistent postconcussive symptoms." – 2010:

https://www.ncbi.nlm.nih.gov/pubmed/20051900

• "Experience with mild traumatic brain injuries and postconcussion syndrome at Kandahar, Afghanistan." – 2010:

https://www.ncbi.nlm.nih.gov/pubmed/21181651

this page has MANY sources on it (and an interesting discussion). but one of the participants noted that the following 5 sources were directly related to this controversy: How soon can the demyelinating process start in mild traumatic brain injury?: https://www.researchgate.net/post/How_soon_can_the_demyelinating_process_start_in_mild_traumatic_brain_injury

Stapert et al 2006 http://arnop.unimaas.nl/show.cgi?fid=4933 Silver et al, 2009 http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2009.08111676 Bigler, 2013a http://journal.frontiersin.org/article/10.3389/fnhum.2013.00395/abstract Le et al 2008 http://online.liebertpub.com/doi/abs/10.1089/neu.2008.0566 Spencer et al 2010 http://online.liebertpub.com/doi/abs/10.1089/neu.2008.0566

Colbey84 (talk) 13:39, 27 November 2016 (UTC)

Decided i should probably put this is a separate section, as i noted in the "Dubious" tag there would be one. It's not so much that i think a Merck online manual is "dubious," but that i thought the way it was being used was. As in, for a sentence talking about malingering and, basically, people lying about their medical symptoms to get a benefit in some other way, the source was a Merck manual that discussed PEDIATRIC PCS.

AND...that Merck page is no longer available. So it can't even be perused to see if Merck truly asserted that children were claiming they had concussive symptoms so they could get a check from someone. I did find 2 available Merck pages, but didn't change that reference because i was unsure what the intent of the original author was.

• Merck Manuals, Professional version, Traumatic Brain Injury

http://www.merckmanuals.com/professional/injuries-poisoning/traumatic-brain-injury-tbi/traumatic-brain-injury

• Merck Manuals, Consumer version, Concussion

http://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/concussion

Colbey84 (talk) 13:46, 27 November 2016 (UTC)

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Yesterday I added a paragraph to say:

Recently hyperbaric oxygen therapy has been found to help the brain recover. Patients were treated with pure oxygen at a pressure of 2 atm absolute^[3] in a series of 40 one-hour sessions.^[4]

This was promptly reverted by User:Sciencewatcher with the comment that the study had no control and that a controlled study of 2012 found no effect. So I reverted back to my versioin with the comment that he should read the reference in New Scientist. Now he has reverted that again saying that New Scientist is not a reliable source for medical information. I doubt that he read the article, because rather than making medical claims, it quotes Lindell Weaver, the author of a study in 2015 which concluded that hyperbaric oxygen therapy was no better than a sham treatment. He admits that the "sham" treatment did involve putting people into a hyperbaric chamber, so actually they were getting a higher-than-normal oxygen pressure, and that "the burden of evidence is starting to suggest there is a favourable effect". The New Scientist article also says that in the new research they could see that the hyperbaric oxygen therapy caused regrowth of blood vessels and nerve fibre in the affected region of the brain. This would not happen in a sham treatment. This is in the "reliable source" in the second reference I gave. But I object to excluding a source like the New Scientist article on the excuse that the magazine is not a reliable reference. Can Sciencewatcher deny that Weaver said the above, just because it's in New Scientist rather than the Lancet? Let's not be slaves to technicalities. Let's try to give readers the most up-to-date information on what's going on in this field of research! Eric Kvaalen (talk) 07:44, 12 November 2017 (UTC)

If you read WP:MEDRS it explains why we don't use sources like newscientist for medical information. Also, your argument doesn't hold water. We know that psychological treatments do in fact cause changes in brain structure. If the hyperbaric oxygen had an effect, you would expect it to be dose dependent, so having mildly elevated pressure would be a valid placebo. That's why we don't use sources like newscientist, because they don't rigorously examine the science. --sciencewatcher (talk) 16:30, 12 November 2017 (UTC)

I find it very frustrating that whenever I add some interesting or potentially useful information to an article like this, someone who has a "watchpoint" set on the article comes along within minutes and, because he has never heard the information before or thinks it's nonsense, reverts my changes. They always cite backup from this or that Wikipedia policy. These people always get the last word, because no one else pays attention, and you can't just revert or you'll be accused of waging an edit war. But Wikipedia policy can be cited both ways. There's a policy saying that we should use second- or third-hand sources rather than first-hand sources because the former show that something is significant and accepted by a wider group than just the researchers. So for example, my New Scientist article says that one of the researchers who hadn't found an effect is now admitting that there probably is an effect (not just placebo). But then Sciencwatcher says that New Scientist is off limits, so we can't even mention this interesting line of research! I'll bet that in a few years it will be clear that hyperbaric oxygen therapy does work and it will be used all over the world. By the way, even if it were a placebo effect, it would be worth doing! Eric Kvaalen (talk) 09:33, 15 November 2017 (UTC)

Look, it's nothing to do with me. Feel free to re-add your change and I won't revert it (but someone else probably will, as it is a clear violation of MEDRS). I would suggest you read up on MEDRS and see why we rely on peer-reviewed secondary sources (which new-scientist isn't). --sciencewatcher (talk) 17:22, 15 November 2017 (UTC)

Hi @Fanman1999: thanks for all your hard work to improve this article. I reversed your edit for now, but it is still archived. Do you mind adding your suggestions here so we can go through them slowly and ensure that all the content is appropriate for Wikipedia before adjusting the article live? I encourage you to also speak with your instructor and consult WP:MEDRS to help determine which sources are appropriate for Wikipedia. This is a tough topic to edit on. You may need to use your instructor as well to help you interpret the secondary study papers that you find. Concussion research is evolving rapidly (and is super interesting), basically anything pre-2017 is outdated. Thanks so much. It is great to see new editors here, we hope that you stick around and help improve the article! JenOttawa (talk) 23:03, 1 December 2021 (UTC)

Pinging @Ian (Wiki Ed): here as well from Wikieducation. The folks at Wikied are excellent at helping students and have a ton of great resources.JenOttawa (talk) 23:07, 1 December 2021 (UTC)

@JenOttawa: Just a heads-up that {{Update inline}} isn't a tag to ask for a more recent source, but to update the text itself (that's why I just removed those tags; they won't be understood). {{Obsolete source}} may fit better, but it won't be clear to a non-expert why 21st-century sources should already be obsolete; you should explain that inside the article, probably best by using the reason= parameter. --Florian Blaschke (talk) 19:20, 20 April 2025 (UTC)

I was bold and removed a small paragraph on chiropractic methods as it was based on one case series report. Here is the removed text (pasted below. If anyone has ideas for how to improve this section with higher quality sources that meet MEDRS please add in.

Upper cervical care 
Post-concussion syndrome can sometimes be the result of a misalignment in the upper cervical spine (neck) specifically the C1 (Atlas) or C2 (Axis) which surround the brain stem. Some individuals have found relief through upper cervical care. An upper cervical chiropractor is a specialist who uses x-rays to identify misalignments in the upper cervical spine then gently repositions the top two bones of the neck. There are currently approximately seven different chiropractic methods of repositioning the C1 bone, however the three most popular techniques are NUCCA (adjustment done by hand), Blair Technique (adjustment done by hand), and Atlas Orthogonal (adjustment done by a machine).[5]

JenOttawa (talk) 17:36, 19 July 2023 (UTC) JenOttawa (talk) 17:36, 19 July 2023 (UTC)

@Dinoz1: if you disagree with this please reach out or discuss here. Happy to work together to improve this article and leave in if we can find higher quality sources.JenOttawa (talk) 17:40, 19 July 2023 (UTC)

There is one recent systematic review here that I just found sharing evidence on non-pharmacological whiplash treatment and mTBI. PMID 33682560. The 6th Consensus on Concussion in Sport would also be helpful for improving this article as they have a recommendation that is based on expert consensus and the results of their systematic review on interventions. JenOttawa (talk) 17:52, 19 July 2023 (UTC)

@JenOttawa: Hi JenOttawa. I apologize for the revert, I had no idea about the weak source, thanks for pinging me and letting me know about this. I was a bit confused on why the IP left no edit summary (which i mistaked for an unexplained deletion). Cheers, Dinoz1 (chat?) (he/him) 18:10, 19 July 2023 (UTC)

Hi @Dinoz1: no problem at all. I am not sure who the IP was either, the edit just caught my eye so I checked the source. I felt badly removing it right after you put it back in, it was not my intention! Have a terrific day! JenOttawa (talk) 18:23, 19 July 2023 (UTC)

This article was the subject of a Wiki Education Foundation-supported course assignment, between 9 September 2025 and 12 December 2025. Further details are available on the course page. Student editor(s): Brainywombat (article contribs).

— Assignment last updated by Brainywombat (talk) 04:32, 6 October 2025 (UTC)

Hello all! I am so impressed with everyone's detailed work and care. I think some parts of this article need to be updated, as science is advancing quickly, and many of the citations are from the 1990s or early 2000s. I am specifically interested in sex differences, and to that end added this sentence and citations. Please feel free to edit, amend or remove!

PCS symptoms are linked to fluctuations in menstrual hormones at time of concussion: specifically the drop of elevated progesterone during the luteal phase is associated with worse outcomes.^[6][7][8] Brainywombat (talk) 04:43, 13 December 2025 (UTC)

ICD-10 is replaced by ICD-11, so the article may need an update regarding this. ∀lquantor (talk) 23:53, 27 February 2026 (UTC)